telephonically assessing, planning, implementing and coordinating all case management activities with members from our Federal Plans
evaluating the medical needs of the member in order to facilitate and promote the member’s overall wellness
developing a proactive course of action to address issues presented to enhance the member's short and long term outcomes
applying data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs
conducting comprehensive clinical assessments
evaluating needs and developing flexible approaches based on member needs, benefit plans or external programs/services
advocating for patients to the full extent of existing health care coverage
promoting quality, cost effective outcomes, and making suggestions to improve program/operational efficiency
identifying and escalating quality of care issues through established channels
providing an expected very high level of customer service
utilizing assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change
utilizing influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health

Must have active, current and unrestricted RN licensure in state of residence and have the ability to be licensed in all non-compact states
Must be willing and able to work Monday through Friday, 8 hour shift between 7am to 5pm Arizona time
Must live in either PST, MST, or Arizona Time zones
3+ years of clinical practice experience required
1+ years of experience utilizing MS Office suites
Case management experience preferred
Case Manager Certification
Associate's degree required
BSN preferred

Case Manager, RN

About this role